Dietary Knowledge, Attitude and Practice (KAP) Among the Family Members of Patients with Type 2 Diabetes Mellitus (T2DM) and Its Influence on the KAP of T2DM Patients

Development and validation of a nomogram to predict medication risk based on a knowledge, attitude and practice (KAP) survey of residents in Shanxi Province, China

Objective

Unsafe medication practices and medication errors are a major cause of harm in healthcare systems around the world. This study aimed to explore the factors that influence the risk of medication and provide medication risk evaluation model for adults in Shanxi province, China.

Methods

The data was obtained from the provincial questionnaire from May to December 2022, relying on the random distribution of questionnaires and online questionnaires by four hospitals in Shanxi Province. Multiple linear regression analysis was used to explore the factors affecting the KAP score of residents. Univariate and multivariate logistic regression was used to determine the independent risk factors, and the nomogram was verified by receiver operating characteristic curve, calibration and decision curve analysis.

Results

A total of 3,388 questionnaires were collected, including 3,272 valid questionnaires. The average scores of drugs KAP were 63.2 ± 23.04, 33.05 ± 9.60, 23.67 ± 6.75 and 33.16 ± 10.87, respectively. On the evaluation criteria of the questionnaire, knowledge was scored "fair", attitude and practice were scored "good". Sex, monthly income, place of residence, insurance status, education level, and employment were regarded as independent risk factors for medication and a nomogram was established by them.

Conclusion

Males, low-income, and low-educated people are important factors affecting the risk of medication. The application of the model can help residents understand the risk of their own medication behavior and reduce the harm of medication.

The Outlook of Healthcare Providers on the Involvement of Diabetic Patients as Health Promoters for Diabetes Prevention Among Their Family Members: A Qualitative Study

Background and objective Examples of patients becoming health promoters for diabetes prevention in their own families, although few, are on the rise. Nevertheless, despite this increase in patient involvement in diabetes prevention, there is scarce research regarding healthcare providers' perspectives on the active engagement of patients as health promoters for their family members. In light of this, we aimed to explore the perspectives of healthcare providers working at primary health clinics regarding patient involvement in diabetes prevention among their own family members and close relatives. Methodology This study was conducted between July and December 2022 at the Primary Healthcare Clinics at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, in Riyadh and Jeddah, Saudi Arabia. Semistructured interviews based on purposive sampling were conducted with 13 participants, and their data were thematically analyzed. Results Two main themes emerged from the interviews: the patients' readiness to be health promoters and the willingness of healthcare staff to support promoter patients. Healthcare providers perceived the involvement of diabetes patients in promoting the health of their family members and close relatives as beneficial; however, several barriers may prevent these patients from becoming effective health promoters. Conclusions Healthcare providers understand the significance of involving patients with diabetes as health promoters for their family members and close relatives. Patients can offer unique insights into the lived experience of diabetes management, as well as provide practical advice for lifestyle adjustments. Nevertheless, healthcare providers should also recognize the limits of patients' knowledge and skills and ensure that patients receive proper training and support to serve as effective health educators.

Level of dietary adherence and determinants among type 2 diabetes population in Ethiopian: A systemic review with meta-analysis

BACKGROUND

The beneficial effect of the dietary practice is significant reduction in the risk of developing diabetes related complication. Dietary practice among type 2 diabetes is not well-implemented in Ethiopia. Up to now, in the nation, several primary observational studies have been done on dietary adherence level and its determinants among type 2 diabetes. However, a comprehensive review that would have a lot of strong evidence for designing intervention is lacking. So, this review with a meta-analysis was conducted to bridge this gap.

METHODS

A systematic review of an observational study is conducted following the PRISMA checklist. Three reviewers have been searched and extracted from the World Health Organization- Hinari portal (SCOPUS, African Index Medicus, and African Journals Online databases), PubMed, Google Scholar and EMBASE. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with low and moderate risk were included in the final analysis. The review presented the pooled proportion dietary adherence among type2 diabetes and the odds ratios of risk factors favor to dietary adherence after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD42020149475.

RESULTS

We included 19 primary studies (with 6, 308 participants) in this meta-analysis. The pooled proportion of dietary adherence in the type 2 diabetes population was 41.05% (95% CI: 34.86-47.24, I2 = 93.1%). Educational level (Pooled Odds Ratio (POR): 3.29; 95%CI: 1.41-5.16; I2 = 91.1%), monthly income (POR: 2.50; 95%CI: 1.41-3.52; I2 = 0.0%), and who had dietary knowledge (POR: 2.19; 95%CI: 1.59-2.79; I2 = 0.0%) were statistically significant factors of dietary adherence.

CONCLUSION

The overall pooled proportion of dietary adherence among type 2 diabetes in Ethiopia was below half. Further works would be needed to improve dietary adherence in the type 2 diabetes population. So, factors that were identified might help to revise the plan set by the country, and further research might be required to health facility fidelity and dietary education according to diabetes recommended dietary guideline.

Adverse associations of different obesity measures and the interactions with long-term exposure to air pollutants with prevalent type 2 diabetes mellitus: The Henan Rural Cohort study

BACKGROUND

Obesity and ambient air pollution are independent risk factors of type 2 diabetes mellitus (T2DM), however, the evidence regarding their joint associations on T2DM was sparsely studied in low-middle income countries.

METHODS

A total of 38,841 participants were selected from Henan Rural Cohort study which was carried out during 2015-2017. Obesity was identified by body mass index (BMI), WC (waist circumstance), WHR (waist-to-hip ratio), WHtR (waist-to-height ratio), BFP (body fat percent), and VFI (visceral fat index). Three-year averaged-concentrations of NO₂, PM₁, PM_2.5, and PM₁₀ were assessed by using the method of spatiotemporal model incorporated into the satellites data. The independent associations of obesity indicators and exposure to air pollutants on fasting blood glucose (FBG) and T2DM were assessed by generalized linear and logistic regression model, respectively, and their interaction associations on T2DM were quantified by using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S).

RESULTS

Positive associations of six obesity measures and four air pollutants with FBG levels and prevalent T2DM were observed. Obese participants measured by BMI plus high exposure to NO₂, PM₁, PM_2.5 and PM₁₀ were related to a 2.96-fold (2.66-3.29), 2.87-fold (2.58-3.20), 2.98-fold (2.67-3.32) and 3.01-fold (2.70-3.35) increased risk for prevalent T2DM, respectively; similarity of joint associations of the other obesity measures and air pollutants on T2DM were observed. The additive associations of different obesity measures and air pollutants with prevalent T2DM were further found.

CONCLUSIONS

The synergistic associations of obesity and air pollutants on FBG levels and prevalent T2DM were observed, indicating that obese participants were at high risk for prevalent T2DM in highly polluted rural regions.

Psoralen Suppresses Lipid Deposition by Alleviating Insulin Resistance and Promoting Autophagy in Oleate-Induced L02 Cells

Non-alcoholic fatty liver disease (NAFLD) held a high global prevalence in recent decades. Hepatic lipid deposition is the major characteristic of NAFLD. We aim to explore the mechanisms of psoralen on lipid deposition in NAFLD. The effects of psoralen on insulin resistance, lipid deposition, the expression and membrane translocation of glucose transporter type 4 (GLUT4), autophagy, and lipogenesis enzymes were determined on sodium oleate-induced L02 cells. Chloroquine and 3-MA were employed. The AMP-activated protein kinase alpha (AMPKα) was knocked down by siRNA. Psoralen alleviated insulin resistance in sodium oleate-induced L02 hepatocytes by upregulating the expression and membrane translocation of GLUT4. Psoralen inhibited lipid accumulation by decreasing the expression of key lipogenesis enzymes. Psoralen promotes autophagy and the autophagic flux to enhance lipolysis. Psoralen promoted the fusion of the autophagosome with the lysosome. Both chloroquine and 3-MA blocked the effects of psoralen on autophagy and lipid accumulation. The AMPKα deficiency attenuated the effects of psoralen on autophagy and lipid accumulation. Our study demonstrated that as an antioxidant, psoralen attenuates NAFLD by alleviating insulin resistance and promoting autophagy via AMPK, suggesting psoralen to be a promising candidate for NAFLD.